28: Endocrine Pancreas

Question 1

where in pancreas are the majority of islets of langerhans

Answer 1

neck and tail

Question 2

five steps of cellular insulin release

Answer 2

1. GLUT2 takes glucose into Beta cells
2. ATP is generated from glucose
3. ATP inhibits membrane K channel
4. Depol -> Ca influx
5. Insulin release

Question 3

what two things are made from proinsulin

Answer 3

insulin + C peptide

Question 4

what is C peptide a marker for?

Answer 4

endogenous insulin

Question 5

two major incretins

Answer 5

1. GLP-1: glucagon-like peptide1

2. GIP: glucose-dependent insulin-releasing polypeptide

Question 6

MOA of incretins

Answer 6

stimulate insulin release + inhibit glucagon release -> lowers blood sugar

Question 7

molecule that inactivates incretins

Answer 7

DPP-4

Question 8

why do Kussmaul respirations occur?

Answer 8

compensatory respiratory alkalosis bc of underlying metabolic acidosis

Question 9

target A1C

Answer 9

6.5 or lower

Question 10

effect on vasculature of glycated end products

Answer 10

1. production of: VEGF, TGF-B, ROS
2. procoagulant activity
3. SM proliferation
4. Matrix protein cross linking

Question 11

unifying features of pancreating neuroendocrine tumors

Answer 11

grossly solid tan/yellow, mostly found in pancreatic neck and tail, secretory granules on EM

Question 12

basal vs bolus insulin

Answer 12

1. basal: long-acting insulin to achieve steady state control
2. bolus: adjusted at mealtime and based on FSG and estimated carb count of meal

Question 13

two other names for HHS: Hyperglycemic Hyperosmolar State

Answer 13

1. NKHS: Non-Ketotic Hyperosmolar State

2. HNKC: Hyperosmolar Non-Ketotic Coma

Question 14

123 rule for fluid replacement in DKA and HHS**

Answer 14

1. DKA: 2-3L in first 1-3 hours -> 150ml/hr

2. when glucose reaches 250: switch to D5 1/2 NS at 100-200ml/hr

Question 15

three things to be sure of before starting a DKA pt on long-acting insulin

Answer 15

1. pt can eat (mental status improving, no N/V/abd pain
2. anion gap normalized
3. allow overlap timing of IV with SQ insulin by 30-60 minutes

Question 16

major cause of mortality in DM2

Answer 16

CV disease

Question 17

two things that can alter A1c results

Answer 17

1. hemoglobinopathies

2. recent blood transfusions

Question 18

three things to do at exams quarterly vs annually for diabetic pts

Answer 18

1. quarterly: A1c, review SGM log, foot inspection

2. annually: dilated eye exam, urine protein screen, monofilament testing

Question 19

foot care tips for diabetic pts

Answer 19

1. daily inspection: use plastic mirror or family assistance if needed
2. dont go barefoot
3. moisturize but not between/under toes
4. prescription shoes
5. podiatry

Question 20

for a diabetic pt, was is the single most additive risk for CV disease?

Answer 20

cigarettes

Question 21

chr associated wth DM1

Answer 21

Chr 6

Question 22

insulinitis

Answer 22

T cell and macrophage infiltrate on histo for DM1

Question 23

three metrics to Dx DM2

Answer 23

1. FPG: 126+
2. 2hr glucose: 200+
3. A1c: 6.5%+

Question 24

mutation in MODY

Answer 24

glucokinase

Question 25

triad of DKA

Answer 25

hyperglycemia + ketonemia + met acidosis

Question 26

ph imbalance in HHS

Answer 26

normal PH

Question 27

things that can cause HHS

Answer 27

MI, sepsis glucocorticoids, thiazides, phenytoin, decreased access to water

Question 28

Kimmelstein-Wilson dz is due to what?

Answer 28

diabetic nephropathy

Question 29

insulinoma histo

Answer 29

amyloid

Question 30

what panc tumor causes gallstones

Answer 30

somatostatinoma

Question 31

4 D’s of glucagonoma

Answer 31

DM, dermatitis, depression, DVT

Question 32

VIPoma presentation

Answer 32

WDHA: water diarrhea, hypokalemia, achlorydia